Although there is research regarding the diagnosis and timing of abusive head trauma, there remains practice variation among pediatric subspecialists.
To examine diagnostic variability among pediatric subspecialists using case examples of infant head injury. Secondary objectives were timing variability among subspecialists, and diagnostic and timing variability among Child Abuse Pediatricians (CAPs).
Pediatric subspecialists were recruited from Child Abuse Pediatrics, Hospital Medicine, Emergency Medicine, Critical Care, and Neurosurgery to complete a research instrument. Participants qualified for the study if they evaluated at least 1 case of possible abusive head trauma during their career.
This multi-institutional, mixed-methods study used a research instrument with 4 case examples of infant head injury: severe retinal hemorrhages (RH), mass-effect subdural hemorrhage (SDH), SDH membrane formation, and sepsis. The response selected by most CAPs was reference and compared across subspecialties and among CAPs using Chi-square or Fisher\'s exact tests. A Bonferroni correction (p < 0.01) was used for subspecialty comparisons.
There were 288 participants who completed at least 1 case example. Diagnostic variability was observed in all case examples. Significantly fewer Hospital Medicine (34.9 % vs. 57.9 %, p < 0.01), Emergency Medicine (28.0 % vs. 57.9 %, p < 0.0001), and Neurosurgery (24.0 % vs. 57.9 %, p < 0.01) participants selected the reference response for the mass-effect SDH case example. Timing variability was statistically significant for all case examples (p < 0.01). Significantly fewer CAPs aged 44-64 years selected the reference response for timing (p < 0.01) for the severe RH case example.
Additional peer review processes and consensus guidelines for challenging issues in abusive head trauma may be beneficial.

BACKGROUND: Convalescent plasma therapy is used for the treatment of critically ill patients for newly discovered infectious diseases, such as coronavirus disease 2019 (COVID-19) pneumonia, under the premise of lacking specific treatment drugs and corresponding vaccines. But the best timing application of plasma therapy and whether it is effective by antiviral and antibiotic treatment remain unclear.
METHODS: We describe a patient with COVID-19, a 100-year-old, high-risk, elderly male who had multiple underlying diseases such as stage 2 hypertension (very high-risk group) and infectious pneumonia accompanied by chronic obstructive pulmonary disease and emphysema. We mainly describe the diagnosis, clinical process, and treatment of the patient, including the processes of two plasma transfusion treatments.
CONCLUSIONS: This provides a reference for choosing the best timing of convalescent plasma treatment and highlights the effectiveness of the clinical strategy of plasma treatment in the recovery period of patients with COVID-19 pneumonia.

The continued spread of COVID-19 suggests a significant possibility of reimposing the lockdowns and stricter social distancing similar to the early phase of pandemic control. We present a dynamic model to quantify the impact of isolation for the contagion curves. The model is calibrated to the COVID-19 outbreak in Spain to study the effects of the isolation enforcement following the declaration of the state of alarm (14 March 2020). The simulations indicate that both the timing and the intensity of the isolation enforcement are crucial for the COVID-19 spread. For example, a 4-day earlier intervention for social distancing would have reduced the number of COVID-19 infected people by 67%. The model also informs us that the isolation enforcement does not delay the peak day of the epidemic but slows down its end. When relaxing social distancing, a reduction of the contagion probability (with the generalization of preventive actions, such as face mask wearing and hands sanitizing) is needed to overcome the effect of a rise in the number of interpersonal encounters. We report a threshold level for the contagion pace to avoid a second COVID-19 outbreak in Spain.

BACKGROUND: Laparostomy is important in the management of patients with intra-abdominal gastrointestinal catastrophe or trauma. It carries significant risk and is resource intensive, both in terms of nursing and surgically. The main goal is to achieve prompt myofascial closure (MFC) in order to minimise morbidity and mortality. Early MFC was initially defined as within 2-3 weeks but there is growing evidence that this should be measured in days.
METHODS: Retrospective analysis was undertaken of laparostomy cases between 2016 and 2018 at an acute trust and trauma centre serving a population of 500,000. Indication, duration of open abdomen (OA), number of relook procedures and consultant presence were examined to see whether they affected MFC rates, morbidity and mortality.
RESULTS: Overall, 76 laparostomies were performed during the 3-year study period. The most common indication was peritonitis (68.4%). As duration of OA and number of relook procedures increased, the chances of MFC fell significantly. After day 1, MFC rates fell by 20% with each subsequent 24 hours. Leaving the abdomen open primarily at index procedure compared with performing laparostomy following a postoperative complication was associated with significantly higher MFC rates (92.6% vs 68.2%, (p=0.006). The mortality rate was 15.8%.
CONCLUSIONS: If the OA is not closed within five days or by the third relook procedure, then achieving MFC is unlikely. Alternative methods should be employed to close the abdomen rather than continuing to take the patient back to theatre for relook laparotomies while increasing the risk of morbidity and mortality. A proactive strategy to forming primary laparostomy at the index procedure has high closure rates.

BACKGROUND: The treatment of diabetic foot ulcers in this case is complex and multidisciplinary, and an interdisciplinary team is extremely beneficial.
METHODS: We performed the intervention on an old type 2 diabetes patient with poor health, whose left toes were severely necrotic. Surgery, including debridement and patella truncation, had positive effects on lower extremity circulation, infection control, cavity treatment, bone destruction, surgical debridement, recovery of foot function, and nursing. After 5 months, the patient\'s foot ulcer had healed, and walking function was preserved.
CONCLUSIONS: Scheduling interventional surgery and debridement are the key point in a complicated diabetic foot ulcers case, and multidisciplinary collaboration in treatment of diabetic foot is significantly important.

Currently, exercise prescription relies heavily on parameters included in the FITT principle: frequency, intensity, time (duration), and type of exercise. In this paper, the benefits of including timing (FITT+T), referring to when exercise is performed in relation to meal-time, is discussed. Current research indicates that timing is outcome-specific. Total energy and lipid intakes, and postprandial hypertriglyceridemia can be reduced when exercise is performed pre-meal, while glycemic control is improved with post-meal exercise. Although findings indicate that timing can aid in obesity management and cardiometabolic-risk reduction, most research involves adult subjects and acute investigations. Some research with children, concerning the effect of timing on appetite, indicates that pre-meal exercise helps regulate energy balance, but also identifies key differences in response compared with adults. Overall, current findings support the benefits of timing, but research is required to establish guidelines that are specific to the pediatric population and their health-related goals, while incorporating other FITT components.

There is a known introspective limitation in the Psychological Refractory Period (PRP) paradigm - people underestimate the dual-task costs on their second reaction time. The prevailing explanation for this is that conscious awareness of the second stimulus is delayed in time until the first task has been centrally processed. Here, we examined this effect in more detail, by comparing reaction time estimates after processing a PRP task, and after passively experiencing \'replays\' of PRP trials. Even when participants had no dual-task processing demands, they did not accurately report the reaction time intervals using a visual analogue scale (the original reporting method of most introspective PRP experiments), but they did when placing markers that represent each event on a timeline. Thus, the timeline seems to better represent participants\' introspective representation of the trial. Importantly, introspection limitations still existed when participants processed the PRP task and then recreated it on a timeline.

When young children answer questions, they do so more slowly than adults and appear to have difficulty finding the appropriate words. Because children leave gaps before they respond, it is possible that they could answer faster with gestures than with words. In this study, we compare gestural and verbal responses from one child between the ages of 1;4 and 3;5, to adult Where and Which questions, which can be answered with gestures and/or words. After extracting all adult Where and Which questions and child answers from longitudinal videotaped sessions, we examined the timing from the end of each question to the start of the response, and compared the timing for gestures and words. Child responses could take the form of a gesture or word(s); the latter could be words repeated from the adult question or new words retrieved by the child. Or responses could be complex: a gesture + word repeat, gesture + new word, or word repeat + new word. Gestures were the fastest overall, followed successively by word-repeats, then new-word responses. This ordering, with gestures ahead of words, suggests that the child knows what to answer but needs more time to retrieve any relevant words. In short, word retrieval and articulation appear to be bottlenecks in the timing of responses: both add to the planning required in answering a question.

Temporal coordination between members of a string quartet was investigated across repeated performances of an excerpt of Haydn\'s string quartet in G Major, Op. 77 No. 1. Cross-correlations between interbeat intervals of performances at different lags showed a unidirectional dependence of Viola on Violin I, and of Violin I on Cello. Bidirectional dependence was observed for the relationships between Violin II and Cello and Violin II and Viola. Own-reported dependencies after the performances reflected these measured dependencies more closely than dependencies of players reported by the other players, which instead showed more typical leader-follower patterns in which Violin I leads. On the other hand, primary leadership from Violin I was observed in an analysis of the bow speed characteristics preceding the first tone onset. The anticipatory movement of Violin I set the tempo of the excerpt. Taken together the results show a more complex and differentiated pattern of dependencies than expected from a traditional role division of leadership suggesting several avenues for further research.

Reports of introspective reaction times (iRTs) have been used to investigate conscious awareness during dual-task situations. Previous studies showed that dual-task costs in RTs (the psychological refractory period, PRP, effect) are not reflected in participants\' introspective reports. This finding has been attributed to conscious awareness of Task 2 being delayed while Task 1 is centrally processed. Here, we test this Temporal model and compare it to an alternative that assumes participants base their iRTs on experienced difficulty. We collected iRTs and difficulty estimates after each trial of a PRP paradigm in which the perceptual difficulty of either Task 2 (Experiment 1) or Task 1 (Experiment 2) was manipulated. Our results largely support the difficulty-based account, suggesting that in a dual-task situation, iRTs do not reflect timing of cognitive processes but are strongly influenced by the experience of difficulty.